Title: EM&S1 W2L2 Interactive Video Placement of a Catheter

Why is it recommended to place your patient in Left Lateral recumbency?

Q1 Feedback
Feedback: It's always recommended, when possible to start by using the right jugular vein as the left side is then available for an oesophagostomy tube if needed.

Q2 MCQ

Q: Where should you premeasure your CVC to? From point of insertion to the point of the elbow where it meets:
- 3-4 ICS (correct) (Feedback: This ensures that the catheter tip sits at the tip of the right atrium (not in it). Note if CVP is not required, it does NOT need to be this far down.) (if not chosen: Feedback: This ensures that the catheter tip sits at the tip of the right atrium (not in it). Note if CVP is not required, it does NOT need to be this far down.)
- 4-5 ICS
- 5-6 ICS

Q: As our patients are only sedated or collapsed it's good to have sedative drugs at hand, ready incase your patient moves and you need them to be more chemically restrained - preferably something that doesn't affect the cardiovascular output too much. Which of the following would be the most appropriate choice?
- Alfaxalone (correct) (Correct! Alfaxalone would be the most appropriate.) (if not chosen: That's incorrect. Alfaxalone would be the most appropriate.)
- Dexmedetomidine
- Acepromazine

Q4 MCQ

Q: What is the onset of action for lidocaine?
- <5 minutes (correct) (Correct! It's normally 1-2 minutes.) (if not chosen: Incorrect! It's normally 1-2 minutes.)
- 5-10 minutes
- 10-15 minutes

[Image: Top Tip]

Q6 MCQ

Q: This is a fairly common complication as the catheter can get caught in the skin. What are your next steps?
- Remove the catheter, keep the wire in place and try a smaller size CVC.
- Remove the catheter, keep the wire in place and use a larger dilator before re-attempting to place the same CVC (if sterility has been maintained). (correct) (Correct! Remove the catheter, keep the wire in place and use a larger dilator before re-attempting to place the same CVC (if sterility has been maintained).) (if not chosen: Incorrect. Remove the catheter, keep the wire in place and use a larger dilator before re-attempting to place the same CVC (if sterility has been maintained).)

[Image: Top Tip]

Ensure you repeat this process with all ports, and ALWAYS have a clip. If the bungs come off or the patient manages to chew the end, then that can lead to an air embolus, and as this goes straight to the heart, this can cause pulmonary complications and sudden death!

Important: Sutures that are too tight will lead to:

- Patient discomfort (and increased interference);
- Phlebitis;
- Septicaemia;
- Bruising;
- Irritation;
- Reduction in amount of time CVC can remain in place- remember you may not be able to place another one either due to cost, vessel damage or the patient's condition!

[Image: Top Tip]

Top Tip! I like to use 'Tegaderm', an adherent transparent dressing which allows you to visualise to insertional site and monitor for any redness, heat, swelling, discharge or clots on your daily checks whilst keeping the site protected.

Q12 MCQ

Q: What is the most common mistake made with CVC bandaging?
- Bandaging too tight (correct) (It is very common for nurses and vets to allow this to be placed too ‘tight’ restricting movement with the patient, causing discomfort and contributing to oedema. Remember also that if the patient is not particularly mobile, it does not need a tight bandage! I will often only apply Soffban to my critical patients with no secondary layer.) (if not chosen: It is very common for nurses and vets to allow this to be placed too ‘tight’ restricting movement with the patient, causing discomfort and contributing to oedema. Remember also that if the patient is not particularly mobile, it does not need a tight bandage! I will often only apply Soffban to my critical patients with no secondary layer.)
- Bandaging too loose
- Bandaging with only one layer

Remember to LABEL all ports as 'CVC', so they are not confused with other lines (such as NG tubes for example!).

Choose the correct statement.

Credits: licence C